A modified surgical procedure for congenital kyphoscoliosis: selective partial hemivertebrectomy via posterior-only approach

Abstract

The study aims to assess the correction efficacy of selective partial hemivertebra excision via posterior-only approach for adolescent patients with congenital kyphoscoliosis. A total of 17 cases (10 M/7 F) were enrolled to this study, all of whom were fully segmented hemivertebra. The mean grade of Risser sign was 1.82 ± 1.07. The average time of follow-up was 20.12 ± 6.88 months. Patients were all treated with selective partial hemivertebra excision and instrumentation via posterior-only approach. The maximal coronal Cobb angle, segmental curves, and segmental kyphotic curves are measured before and after operation, and at the latest follow-up. The data was analyzed to evaluate the correction efficacy. There were no postoperative infections and no neurological complications in all patients. The mean size of the segmental curve was 38.65 ± 5.35° before operation and 13.55 ± 1.82° after operation, with a mean correction of 25.10 ± 5.44°, which turned to 16.59 ± 2.14° at latest follow-up. The mean maximal coronal Cobb angle was 42.90 ± 7.96° before operation, 14.68 ± 2.44° after operation, and 17.50 ± 2.64° at the latest follow-up, giving a correction of 65.7%. The correction rate of segmental kyphotic curve was 72.6%, as the mean segmental kyphotic angle was 22.64 ± 6.74° before operation, 6.15 ± 2.50° after operation, and 6.9° at the latest follow-up, with a loss of 6.90 ± 2.68°. For the patients whose congenital kyphoscoliosis are due to hemivertebrae, selective partial hemivertebra excision and instrumentation via posterior-only approach is recommended to those ranging from 9 to 14 years old, with the Risser sign range grades 0-3 and Cobb angles <60°. This individualized treatment can balance the growth on the two sides of the spine and achieve satisfactory therapeutic effect through removing excrescent growth center.